Saw my surgeon today and got my date.

17th Jan. Lapband removal, possible hiatus hernia repair and revision to RNY

I got my date today, January 30th. I’m in disbelief that it was approved. I went through the process in 2016 only to be denied due to a miscommunication by my insurance 8 months prior. I was devastated and ended up quitting my job to find one with better insurance. At new employee orientation I requested a detailed list of approved procedures, lol. I don’t think I’ll fully believe that it’s really happening until they roll me into the operating room.

How exciting! Not long now, can't wait to see how we all go with our surgeries and weightloss.

Good morning.

So this evening I will be going to my first support group meeting. I'm kind of excited to meet up with others on the same boat.
This group is actually at my Doctor's office (he has a HUGE conference room). There are 3 Doctor's in the group, so I am hoping plenty of people show up. They also make it known in the community that you do not need to be one of their patients to attend the group, so that I really nice.

Tonight's meeting is a potluck. LMAO I am making sweet and tangy meatballs. I hope that is good enough to bring.

My husband is also coming with me tonight. I am kind of shocked by this. It's not that he isn't supportive of my decision, because he is. He's just one that basically lets me take the lead on things and he waits for me to give him information.

Howdy! I'm hoping to be part of this group! We shall see

23 minutes ago, Kimmie K said:

Howdy! I'm hoping to be part of this group! We shall see

Hi Kim!!!
Nice to meet you.

Have you started the process?

5 minutes ago, Jenwill630 said:

Hi Kim!!!
Nice to meet you.

Have you started the process?

Nice to meet you too! I see my surgeon for the first time on Monday 12/03. My new insurance that covers bariatric won't go into effect until 01/01/19 so depending on if I need nutrition visits or not, January would be the soonest I could have surgery. I think that's too quick though. Won't truly know until my plan enrollment is complete and the surgeon can run the claim (or whatever they call it LOL) to find out the minute details. I've been part of this forum for 10 years, back when it was still called LapBandTalk so being able to FINALLY do this surgery is a long time comin'! ?

8 minutes ago, Kimmie K said:

Nice to meet you too! I see my surgeon for the first time on Monday 12/03. My new insurance that covers bariatric won't go into effect until 01/01/19 so depending on if I need nutrition visits or not, January would be the soonest I could have surgery. I think that's too quick though. Won't truly know until my plan enrollment is complete and the surgeon can run the claim (or whatever they call it LOL) to find out the minute details. I've been part of this forum for 10 years, back when it was still called LapBandTalk so being able to FINALLY do this surgery is a long time comin'! ?

I am changing insurance too.

I am currently on my husbands and they do not cover Bariatric services.
My employers insurance does, so I am switching back to this.

In the meantime, I already asked my HR department to look into what is covered for me plus I double checked by going on the Highmark BCBS DE website and looking at the medical policy....which was actually changed in September to where there is no set amount of time for supervised diet any longer.
So I selected a surgeon that is on both my current plan and my future plan so I could get the ball rolling on everything and that first week of January, they will submit to my new insurance.

41 minutes ago, Jenwill630 said:

I am changing insurance too.

I am currently on my husbands and they do not cover Bariatric services.
My employers insurance does, so I am switching back to this.

In the meantime, I already asked my HR department to look into what is covered for me plus I double checked by going on the Highmark BCBS DE website and looking at the medical policy....which was actually changed in September to where there is no set amount of time for supervised diet any longer.
So I selected a surgeon that is on both my current plan and my future plan so I could get the ball rolling on everything and that first week of January, they will submit to my new insurance.

I am SO glad I met you here! We're literally in the same kind of boat We definitely need to keep in touch.

It's awesome to hear that diet consults are no longer required for your BC plan! Do you remember where on their website you found that or did you have to call? Only thing I wish they had was online chat. UnitedHealthcare had great support chat, but that was about it LOL

My new insurance plan is through Anthem Blue Cross. I'm in Texas, but my company is based out of California so we get the same coverage that they do. Even though I can't log in to the Anthem BC site yet, I have my entire plan's documents and not one thing about dietary evaluations is being mentioned as a requirement for approval. Not even in the EOC which is the most detailed document of all. Only requirements mentioned in the EOC are these (see screenshot below)...this is the full section on anything Bariatric Surgery under "Covered Services" in the entire 191 page document. There's some stuff scattered elsewhere regarding the required type of bariatric surgery facilities and travel coverage for bariatric services, but nothing else for the surgery requirements itself. Next section is Transgender Services, which awesomely, are covered. This policy is beyond generous. Thoughts?

Edited November 29, 20187 yr by Kimmie K

21 hours ago, Kimmie K said:

I am SO glad I met you here! We're literally in the same kind of boat We definitely need to keep in touch.

It's awesome to hear that diet consults are no longer required for your BC plan! Do you remember where on their website you found that or did you have to call? Only thing I wish they had was online chat. UnitedHealthcare had great support chat, but that was about it LOL

My new insurance plan is through Anthem Blue Cross. I'm in Texas, but my company is based out of California so we get the same coverage that they do. Even though I can't log in to the Anthem BC site yet, I have my entire plan's documents and not one thing about dietary evaluations is being mentioned as a requirement for approval. Not even in the EOC which is the most detailed document of all. Only requirements mentioned in the EOC are these (see screenshot below)...this is the full section on anything Bariatric Surgery under "Covered Services" in the entire 191 page document. There's some stuff scattered elsewhere regarding the required type of bariatric surgery facilities and travel coverage for bariatric services, but nothing else for the surgery requirements itself. Next section is Transgender Services, which awesomely, are covered. This policy is beyond generous. Thoughts?

Good morning!

Yes we are in the same boat. And the funny thing is that I also have an out of state policy. LOL I live in PA, but my paret company's US headquarters are in Delaware, so I have Highmark Delaware.
Heck we are just about the same weight too!

Make sure you ask your HR department that it is covered! My current insurance is Aetna. Well Aetna sure does have a section regarding bariatric services, however, my husbands employer does NOT have a bariatric rider. I am glad that I had called to verify because i would have been SO PISSED if I had started my journey only to get denied.....and I have read this exact thing playing out on a few different forums.

I had found my info in the medical policy section. Once I went in there, I then did search for Obesity and the policy change popped up:

2 minutes ago, Jenwill630 said:

Good morning!

Yes we are in the same boat. And the funny thing is that I also have an out of state policy. LOL I live in PA, but my paret company's US headquarters are in Delaware, so I have Highmark Delaware.
Heck we are just about the same weight too!

Make sure you ask your HR department that it is covered! My current insurance is Aetna. Well Aetna sure does have a section regarding bariatric services, however, my husbands employer does NOT have a bariatric rider. I am glad that I had called to verify because i would have been SO PISSED if I had started my journey only to get denied.....and I have read this exact thing playing out on a few different forums.

I had found my info in the medical policy section. Once I went in there, I then did search for Obesity and the policy change popped up:

11 years ago, before I was well-versed in how insurance worked, I went through all the testing and medical approval process with a surgeon for LapBand just to find out that there was an exclusion on my policy for weight loss surgery once they submitted my claim to the insurance company. That news was absolutely devastating. I dropped the phone and ugly cried at my desk at work very loudly for a few minutes. SO...in an effort to prevent history from repeating itself, I've triple and quadruple checked everything with HR and they've confirmed, for sure, that bariatric is covered. I think surgeons might've done things differently back then or something...kind of bass-ackwards if you ask me. Nowadays, your eligibility is confirmed before you start. Who knows...maybe my surgeon's office back then was just crappy.

I just completed open enrollment yesterday for the new policy so once that's goes through, I'll feel much more comfy about things. since the surgeon will have a way to confirm all the details. I'm curious to see how things work out with you too so keep in touch!!!

So I'm not sure if I'll be in this January group or not - here's to hoping.

I started the whole process of tests, psychiatric review, and 6 mos of monitored weight loss, etc 9 mos ago. The nurse said she submitted the paperwork on Wednesday of this week to BC/BS and it takes 15 days for review/approval.

The nurse says they (not sure if that's the doc or BC/BS of Mass) have a surgery date but just haven't told me? Is that unusual?

You'd think they would try to coordinate with me to make sure I was available work wise, made arrangements with family, etc.

Edited December 2, 20187 yr by watertolive

Good Luck Watertolive, no matter when it turns out to be! You're among friends HERE!

Hello!! Just snooping around for January Surgery Twins

My op date is January 16th - going in for a revision from GS to RNY due to the "usual" complications - Hernia, Acid Reflux so bad it makes your head spin and a general lack of any real progress. I am 3.5 years out from my sleeve and while it worked wonderfully for the first 2.5-3 years, the GERD and its friends have me back tracking.

Nervous in general - normal to be, I suppose, but overall, very excited to have this surgery as I hear it almost immediately takes care of the acid reflux. and WOW, is that ever a drain on your energy and your life.

So that's a little about me. Looking forward to hearing more from all the other January People!

January here! Dont have specific day yet but I do know January!

On 12/1/2018 at 8:28 PM, SimoneMonet said:

So I'm not sure if I'll be in this January group or not - here's to hoping.

I started the whole process of tests, psychiatric review, and 6 mos of monitored weight loss, etc 9 mos ago. The nurse said she submitted the paperwork on Wednesday of this week to BC/BS and it takes 15 days for review/approval.

The nurse says they (not sure if that's the doc or BC/BS of Mass) have a surgery date but just haven't told me? Is that unusual?

You'd think they would try to coordinate with me to make sure I was available work wise, made arrangements with family, etc.

I don't know if it's unusual or not but you could always call your doctor and ask. It's them, not the insurance company the sets the date. In fact, a MD can't even submit a prior auth request without including some kind of date. Even if it's tentative. It should take 15 days for the review. I'd my insurance Monday. and Wednesday if I were you. Not necessary but it stopped me from going crazy with what ifs lol.